Left Cubital Fossa Research Articles

Lethal Self-Administration of Atracurium: A Rarely Reported Case with Review of Literature.

Atracurium besylate is a nondepolarizing skeletal muscle relaxant first introduced in 1980. It is used during endotracheal intubation. It causes muscle relaxation during surgery or mechanical ventilation. When people consider suicide, they employ drugs found in their surroundings but not usually injectable muscle relaxants, which are not widely available. Studies on their use in suicide are rarely reported worldwide. This was a case of a 34-year-old male nursing staff, working in the general surgery department's operation theater complex, who was found unconscious in bed in his room in the morning with an empty syringe by the bedside. He was declared dead when brought to the emergency department. Forensic autopsy was conducted, and during the external examination, a needle puncture wound was found over the left cubital fossa. No other external other injuries were observed throughout the body. The toxicological analysis report indicated the presence of laudanosine in the vitreous humor, blood, urine, and skin from the puncture site and underneath vein. Also, the toxicological analysis of the empty syringe found at the crime scene revealed the presence of atracurium, confirming that the victim had administered a lethal dose of atracurium.

Pattern of superficial venous arrangement in cubital fossa among preclinical Nepalese MBBS students at Birat Medical College Teaching Hospital

Background: The superficial veins of the cubital fossa are frequently variable in existence and arrangement. Many clinical procedures, such as reconstructive microsurgery and arterial bypass surgery, as well as intravenous injections or therapy, require the use of superficial veins. Aims and Objective: The aim of the study was to observe and describe the variations in anatomical distribution of the superficial veins of the cubital fossa in Nepalese pre-clinical medical students. Materials and Methods: The cross-sectional study included a total of 98 students between 18 to 24 years of age. A total of 196 anterior aspects of both arms were examined for cubital venous pattern. A tourniquet was applied at the mid-arm and drawing of the pattern of veins was made on a separate unglazed paper. The venous patterns in the cubital fossa were then categorized based on their gender. Results: Six patterns of superficial veins of the cubital fossa were observed. The commonest pattern in both genders was type I pattern. No statistical significant difference was observed between patterns of superficial veins on the right and left cubital fossa (P = 0.728 and 0.825 respectively) in both male and female subjects. Conclusion: Our research showed six venous patterns of superficial veins at the cubital fossa in Nepalese population. Understanding the common anatomy, patterns and variations of superficial vein anastomosis is imperative as this knowledge would help those needing venous access for various medical procedures.

Pseudoaneurism of the brachial artery mimicking a soft tissue sarcoma: Case report

The current case is one of the rare clinical presentations of the brachial artery pseudo aneurysm presentation in children Pseudo-aneurism is one of the late complications of a missed or untreated arterial injury. The diagnosis is suggested in the presence of clinical signs such as: an expending, ill-defined mass with or without pulsation; bruit, pain, paresthesia, or paralysis due to nerve compression. Although plain X-Rays may show a nonspecific soft tissue mass, arteriography is essential in defining differentiating pseudo aneurisms from other soft masses. We report a case of a 10years old boy with a history of a stab injury in a well vascularized left cubital fossa region. The physical examination revealed a soft tissue mass with eroded skin. Ultrasound and MRI findings were respectively of an infected soft tissue mass and probable malignant soft tissue mass. Open biopsy was planned but surgical finding revealed a pseudo aneurism of the left brachial artery before its bifurcation. Brachial arterial lesion was repaired blood flow reestablished with clinical improvement.

Skin pH and its relationship with transepidermal water loss and disease severity in children with atopic dermatitis: A cross-sectional study

Background: pH is increasingly a target in therapeutic strategies for skin barrier repair, but the relationship between pH, transepidermal water loss (TEWL), and atopic dermatitis (AD) severity is not well characterized. Purpose: The purpose of the study was to determine the relationship between skin pH with TEWL and their correlations with AD severity. Methods: A cross-sectional study enrolled children aged 4–12 years with AD. Measurements were made using HI 99181 and Tewameter TM 300 at two lesional sites and two nonlesional sites (left cubital fossa, left thigh, and forehead). Disease severity was evaluated using the Eczema Area and Severity Index (EASI) and pruritus score. Results: A total of 14 (58%) girls and 10 (42%) boys aged 7.3 ± 2.6 years with age of AD onset 3.0 ± 2.1 years participated. The mean EASI score was 8.9 ± 8.2, body surface area 13.1% ± 18.5%, pruritus score 5.9 ± 2.7, and Children Dermatology Life Quality Index 5.6 ± 4.9. pH and TEWL were higher at lesional compared to nonlesional skin, pH 5.2 ± 0.7 versus 4.6 ± 0.4, P < 0.01 and TEWL 31.1 ± 15.2 versus 16.0 ± 10.2, P < 0.01. Lesional pH positively correlated with TEWL (r = 0.59, P= 0.02 and r = 0.55, P = 0.01), while nonlesional pH was inversely correlated (r = −0.42,P = 0.04 and r = −0.40, P = 0.05). pH showed significant positive correlations with EASI and itch at one lesional site. Conclusion: pH and TEWL were higher at lesional skin. pH correlated positively with TEWL at lesional skin but inversely at nonlesional areas. Higher pH was associated with disease severity and itch. pH restoration may have therapeutic potential in AD.

Patterns of superficial veins the cubital fossa among young adults in Tanzania

Background The cubital fossa can be seen superficially as a depression on the anterior side of elbow. It is a common site for removal of blood for analysis, for blood transfusion and intravenous therapy. The superficial veins of upper limbs follow three major veins which are cephalic, basilica and median cubital veins which are variable among individuals. Objectives The aim of the study was to observe and describe patterns of superficial veins in the cubital fossa of MUHAS students, and to assess if there were variations of patterns between left and right cubital fossas, also between male and female participants. Methodology The cross sectional study was designed. Convenient sampling was used to select 170 participants among Muhimbili University students ranging from 21-34 years of age who had visible superficial veins at the cubital fossa. A tourniquet was tied at mid arm level and superficial veins in the cubital fossa were photographed and described into various patterns. Results The commonest pattern was Type A which is N shaped, where median antebrachial vein divides to median cephalic and median basilica which joins cephalic and basilica veins respectively with the percentage of 37.6%. Incidences of type B, C, D, E and F were 17.1%, 26.5 %, 1.8%, 15.3% and 1.8% respectively on the left cubital fossa. There were variations between left and right cubital fossa patterns among same individual in some participants and no variations between male and female superficial venous patterns of cubital fossa. Conclusion Understanding various patterns of superficial veins in the cubital fossa is important in clinical practices since it helps easy locating of common superficial veins in procedures such as venipuncture, blood transfusion, intravenous therapy and arteriovenous fistula. Also there are few studies done in Africa and no studies done in Tanzania about superficial venous patterns in the cubital fossa. Key words: superficial veins, cubital fossa, patterns.

Anesthetic potential of lidocaine/prilocaine cream versus placebo before venepuncture

Background: Pain associated with venepuncture has long been accepted as an unavoidable consequence. Many studies show reducing pain during venepuncture after application of prilocaine/lignocaine, but there are few studies that has depicted, the depth of anesthesia produced by prilocaine/lignocaine tends to be too superficial for the reducing the pain during venepuncture. These two scenarios were debatable. Therefore, authors planned a study to assess anesthetic potential of lidocaine /prilocaine cream versus placebo before venepuncture with help of VAS in an adult patient who were drawn blood sample for investigation purposes.Methods: Prospective interventional study. All adult patient for blood sampling from surgery OPD to central laboratory were included in study. Site of venepuncture selected in both control and study group was left cubital fossa. 30 patients selected in study group received lignocaine/prilocaine locally, 30min prior to venepuncture which was later covered with occlusive tape, whereas 30 control group patient received normal saline locally as placebo. The extent of pain was assessed by patient on 10cm visual analogue scale (VAS) with end points of 0 cm rated as no pain and the points of 10cm as intolerable pain.Results: A total of 60 patient were randomly selected who were referred from surgery OPD for blood sampling. Other 30 patient were applied normal saline as placebo and 30 patient with lignocaine and prilocaine cream. In the control group there were 30 patients (5 female and 25 male). In the study group there were 30 patients (8 females and 22 males). The level of pain among study group is as follows: mild 22, moderate 7, worst 1 and in control group: no pain 0, mild 5, moderate 14 and worst pain 1. Statistical analysis between outcome of two groups done by calculating chi-square test. Chi- square test was 20.0263. P value is 0.000168. Hence the result is significant at p &lt;0.05.Conclusions: The present study shows that prilocaine-lidocaine cream reduces the pain of needle puncture in adults and facilitates the procedure of venous blood sampling.

Commercial Acetic Acid: A Potential Regenerative Agent for Chronic Cutaneous Wounds? A Quasi-Experimental Study

BACKGROUND: The acetic acid in the form of vinegar has been used for medicinal purposes since ancient times. Acetic acid is reported to be used for medicinal uses at 1-5% concentration. The mechanism behind the regenerative potential of commercial acetic acid has not been fully explored.MATERIALS &amp; METHODS: Twelve Iraqi patients with chronic skin ulceration were admitted and managed at a Dermatology clinic. Patients included men (7) and women (5) of diverse age groups (23-81 years). The aetiology behind the skin ulceration included; diabetic ulcer, decubitus ulcer, and others induced by trauma, bone fracture, insect bites and substance abuse. All patients were strictly treated with commercial acetic acid (at 4-6% concertation) and followed-up in time until the complete resolution of their cutaneous ulcerations.RESULTS &amp; DISCUSSION: This study is quasi-experimental; two cases are discussed thoroughly; the first case belongs to a Caucasian male aged 26 years with schizophrenia and addiction towards psychoactive substances; he developed a refractory ulcer in left cubital fossa following an intravenous injection. The second case belongs to a middle age male patient, hypertensive otherwise healthy; he had a displaced intra-articular fracture affecting the distal end of the left radius; it was surgically treated with an internal fixation which was incriminated for the development of an ulcer over the volar aspect of left forearm overlying the internal fixation site. Local disinfection with commercial apple vinegar was very effective in restoring the skin integrity with minimal scarring.CONCLUSION: The regenerative potential of acetic acid has been marginally covered in the literature. The presented cases indicate a regenerative potential or at least an accelerant role in the process of cutaneous wound healing and repair.

True aneurysm of proximal radial artery

True aneurysm of upper limb arteries is a rare entity with very few reported cases. Here, we report a case of true aneurysm of proximal radial artery starting from its origin at brachial artery bifurcation. A 50-year-old female presented with a painful pulsatile mass in the left cubital fossa of 1 year duration. Duplex examination revealed partially thrombosed large aneurysm of proximal radial artery. Aneurysmal segment was resected and end of distal brachial artery anastomosed end-to-end with ulnar artery. Radial artery was reconstructed with interposition reversed saphenous vein graft from side of brachial artery to end of radial artery.

Detection of metabolites of vecuronium bromide in visceral samples solves a typical death mystery- (toxicokinetics- studies using Gc-Ms technique)

Introduction: On Sudden death of a medical student (20 year old girl) of National Institute of Medical Science autopsy materials along with site of injection were sent to F.S.L. It was informed during investigation that the girl took tetanus vaccine before death. In crime scene investigation Forensic Team observed that it was a case of gross negligence of dispensing wrong injection. Material: Tests were performed on viscera material viz., liver, spleen, kidney, lungs, brain, skin and blood etc. Mystery of suspected death was solved when a new GC-MS application was designed to get the unknown drug and various fragments of extracted material were studied. Method: A new method was developed on gas-chromatography-mass spectrophotometer and TL.C using various solvent systems is explained. Results: Metabolite fragments of vecuronium bromide a muscle relaxant were surprisingly observed in Viscera material, Blood sample and Skin piece from Left cubital fossa from this young girl, whose death is questioned. Conclusion: Structural elucidations of fragments provide a new approach to toxicokinetics. The explanation of fragments obtained were structurally compared with other neuromuscular blocking groups like atracurium and succinyl choline The presence of bromide attached cholest-5-en-Br, hydroxylated cholest-5-en-ol as hydroxylated product, acetylated fragments as cholest-5-enacetate and piperidone-2-one present in visceral samples indicates structural part obtained from vecuronium bromide drug. These metabolites studies makes the case studies highly informative. Beside this new method of extractions, TLC systems and colouring reagents are also explained.

Good Response to Chemotherapy Spares Irradiation for Extrarenal Rhabdoid Tumor Conferring Better Activities of Daily Living

A 7-year-old girl with stage IIA extrarenal rhabdoid tumor near the left cubital fossa received preoperative chemotherapy and surgical resection with median nerve reconstruction followed by postoperative high-dose chemotherapy. As preoperative chemotherapy resulted in decreased tumor size, disappearance of fluorodeoxyglucose-uptake, and pathologic complete response with total tumor resection, irradiation was successfully spared to avoid injury to the reconstructed nerve and inhibition of normal bone development. Two years after diagnosis, recurrence has not been observed and median nerve palsy is improving. This case suggests that radiation therapy could be spared for clinically and pathologically chemotherapy-good-responders in case total surgical resection is achieved.

Topical Anesthetic Effect of EMLA and Iranian Products in Preventing Pain During Intravenous Blood Sampling Procedures: a Double-Blind Randomized Clinical Trial

Background: The patients’ concerns about injection pain can cause some unwanted adverse reactions such as hypotension, vasovagal shock, syncope, and unconsciousness. Therefore, using a skin anesthetic can facilitate performing many medical procedures. Objectives: This double-blind randomized clinical trial was designed to compare the anesthetic effect of topical EMLA 5% cream with Iranian lidocaine 5% and benzocaine 5% creams. Patients and Methods: Sixty-four healthy volunteers were randomly allocated into two groups. In each individual, EMLA cream and one of Iranian topical anesthetic products, namely lidocaine 5% and benzocaine 5%, were tested. One hour before blood sampling, a predetermined amount of A or B cream was used on the right cubital fossa and the same amount of C or D cream on the left cubital fossa. Blood sampling was done via cubital fossa veins with a 2 cc syringe. The pain of blood sampling was recorded using visual analogue scale (VAS). Data were analyzed by student t-test and ANOVA using SPSS version 11. Results: At the end of study, the EMLA products (A and B) caused a significant decrease in pain (P < 0.05) in comparison with the products C (lidocaine) and D (benzocaine) while there was no differences between benzocaine and lidocaine. In this study, no significant side effect was observed. Conclusions: Although the results of this study showed superiority of application of EMLA cream as a topical anesthetic for pain relief of blood sampling, both lidocaine 5% and benzocaine 5% offer considerable efficacy in pain relief of venipuncture.

Pattern of Superficial Venous of the Cubital Fossa among Volunteers in a Tertiary Hospital

Background: The cubital fossa can be seen superficially as a depression on the anterior side of elbow. The arrangement of the superficial veins in the cubital fossa varies from race to race. Objective: The aim of the study was to observe and describe the variations in anatomical distribution of the superficial veins of the cubital fossa among three major ethnic groups in Malaysian population. Methodology: A cross sectional study was designed to examine the pattern of superficial veins of the cubital fossa among the randomly selected volunteers in Hospital Kuala Lumpur. A total of 300 volunteers including both staff and medical students belonging to three major ethnicities i.e. Malays, Chinese and Indians aged from 18 years or above were selected for cited purpose. Consent was taken and duplex ultrasound was performed using a single ultrasound machine from Philips manufacturer. The venous pattern of the cubital fossa from the right and left cubital force in each subject was drawn on a separate observational sheet. Based on gender and ethnicity the categorization of venous patterns in the cubital region among the volunteers was done. Results: Six patterns of superficial veins of right and left cubital fossa were observed and the commonest pattern in both genders was median cubital vein joined from cephalic to basilica vein. Using Pearson Chi-Square test, it is shown there was no statistical significance difference between patterns of superficial veins on the right and left cubital fossa with gender since p value was 0.498 and 0.999 respectively. However, a pattern of superficial veins on the right and left do have a relationship with ethnicity since its p values were 0.040 and 0.008 respectively. Conclusion: There were significant associations between the pattern of superficial veins on the right and left

An atypical impaling injury of the iliofemoral region

A 46-year-old man with a history of chronic alcoholismwas found at his home address dead lying next to barrelsfilled with flammable liquids and an iron picket fence witha gate into a nearby a forest area (Fig. 1). Examination ofthe scene revealed blood traces with pubic hair coveringthe surface of some of the iron spikes of the gate (Fig. 2).An emergency doctor evaluated the decedent and describeda bizarre tear-like wound of the right femoral region.Because of the unclear cause-of-death determination, thebody was referred for a medico-legal autopsy evaluation.External examination of the adequately nourished,174 cm, 80 kg adult male showed an apparent, channel-like tissue defect of the right femoral region with evidenceof multiple blunt impacts, as well as superficial sharp forcewounds, over the entire anterior surface of the body(Fig. 3). On the right anteromedial aspect of the proximalportion of the femoral region there was an extensive(20 9 20 9 13 cm), obliquely oriented, and irregularlyshaped laceration (Fig. 4a). The wound path penetrated andtransected the quadriceps femoris muscle, the right femoralartery, and vein and entered the right inguinal region(Fig. 4b). The wound track then ascended through theretroperitoneal space and pierced the right psoas majormuscle. There was pronounced hemorrhage into the softtissues along the wound channel and around the pubicregion (Fig. 4c). In addition, four cm to the left of theabove laceration, another obliquely oriented skin perfora-tion was discovered measuring three cm in its largestdimension, that communicated with the impaling wound.The anorectal area was free of injuries. As indicated,multiple abrasions, contusions, and sharp force woundswere also found: on the ventral aspect of the upperextremities there were multiple, small, irregularly shapedcutaneous abrasions, and one deep cutaneous laceration inthe left cubital fossa; on the anterior aspect of the thoraxthere were two oval contusions and multiple longitudinalabrasions. External examination of the lower extremitiesalso disclosed multiple abrasions, contusions, and superfi-cial incised wounds. Internal examination did not show anyother injuries except those described. Toxicological eval-uation of blood revealed a blood alcohol level of 220 mg/dL. Further toxicological investigations of the blood andurine were negative.The cause of death was extensive external blood losscaused by transection of the right femoral artery and veinas a result of an atypical impaling injury.It appeared that the decedent, under the influence ofalcohol, tried to climb over the picket fence and wasaccidentally impaled through the right femoral region.Thus, the manner of death was classified as accidental. Weassume that repeated falls prior to the fatal event and theuncoordinated movements and striking of the body againstthe fence while impaled was a plausible explanation for themultiple blunt force injuries on the anterior aspect of thebody.DiscussionRare injuries, such as impalements are sometimesencountered at autopsy. Impaling injuries usually result

Fatal necrotizing fasciitis following two suicide attempts with petroleum oil injection

Necrotizing fasciitis is an aggressively progressing complication of the skin and soft tissue infections. It has dramatic course and often leads to patient's death. In our research, we present the casuistic case concerning double suicide attempt with petroleum oil injection, complicated by the necrotizing fasciitis, patient was with deliberately withheld mental disorders. During the first suicide attempt, the oil substance was injected into the left cubital fossa and left toes areas, what lead to amputation of the upper left limb above the cubitial fossa and the left toes. Afterward, patient gradually recovered and survived. Two years later, another suicide attempt took place with the same substance: a 27-year-old man injected the petroleum oil into the right supraclavicular area. That affected a necrosis penetrating into the mediastinum and the patient died. To our knowledge, such case of the necrotizing fasciitis has not been previously reported. The mechanism of derivatives of oil influence on tissues is not investigated yet; therefore, treatment method is uncertain and sometimes ineffective.

Seroprevalence of hepatitis B surface antigenemia among health care workers in a Nigerian tertiary health institution.

The aim of this study was to determine the seroprevalence of Hepatitis B surface antigenaemia among the health care workers at the Federal Medical Centre, Ido-Ekiti, Nigeria. The study was carried out on all the staff members in the employment of the Federal Medical Center, Ido Ekiti, Nigeria as at 30th April 2003. Data were collected by administering a set of questionnaire to every member of staff. Blood samples (3mls) were taken from the left cubital fossa of all the respondents and Hepatitis B surface antigen status determined using the agglutination kits manufactured by Biotech Laboratories USA. A total of 420 staff members were screened. 168 (40%) were males while 252 (60%) were females. Only 18 were found to be positive for Hepatitis B surface antigen giving a prevalence of 4.3%. 9 (50%) of those that were positive for Hepatitis B surface antigen were ward maids/attendants, 6 (33%) were nurses, 2 (11%) were administrative staff and 1 (6%) was a health record staff. Health care workers are at increased risk of having hepatitis B infection. Health education should be carried out routinely in our hospitals to raise the awareness level among the hospital staff and standard safety measures such as sharps policy should be adopted in the handling of blood products and sharps.

A fatal case of pontine hemorrhage related to methamphetamine abuse

In this report, we describe a fatal case of pontine hemorrhage related with methamphetamine abuse. A 54-year-old male was found dead in a prone position in his parents’ house, and a medico-legal autopsy was carried out to determine the cause of his death. Externally, although an injection mark-like injury with subcutaneous hemorrhage was observed in the left cubital fossa, the autopsy revealed no severe trauma leading to death. Internally, every organ was moderately congested. The brain weighed 1330 g. Macroscopically, there was no vascular abnormality such as aneurysm or malformation. In the sections of the brain stem, a massive hematoma occupied the central area of the pons. Drug screening test using Triage™ was weakly positive for amphetamines. Moreover, in the blood and urine samples, methamphetamine was quantitatively detected at concentrations of 0.4 and 0.6 mg/l, respectively, by gas chromatography–mass spectrometry. Other drugs and poison were not detected in the blood and urine samples collected at autopsy. Histopathologically, necrotizing angiitis characterized by fibrinoid necrosis of the intima and media was observed with cell infiltration. Thus, the pontine hemorrhage seemingly resulted from methamphetamine-induced angiitis, with an acute elevation of blood pressure after methamphetamine abuse.

Blastomycosis in a South Indian patient after visiting an endemic area in USA

We describe a case of blastomycosis in a diabetic patient from South India who had visited Milwaukee, Wisconsin, an endemic area for blastomycosis in the USA. After his return to Bangalore, India, the patient developed intermittent fever of moderate to high grade, cough, loss of weight and appetite, and abscesses in the left cubital fossa and thigh regions. Systemic examination at our hospital revealed that he had dullness to percussion over the chest region and decreased breath sounds. Direct examination of Gram-stained smears of the pus from an abscess showed many broad-based budding yeast cells and culture yielded a dimorphic fungus later identified as Blastomyces dermatitidis. Histologic examination of the curettage tissue slides stained with hematoxylin and eosin, periodic acid Schiff's reagent, and Gomori's methenamine silver stain procedures showed many broad-based budding cells characteristic of B. dermatitidis. The patient was successfully treated, initially with amphotericin B, followed by oral itraconazole for a period of 6 months. Blastomycosis cases in India are reviewed and the likely source of infection in this patient is discussed.

Letaler Verlauf einer Gasbrandsepsis bei pancytopenem Patienten

History A 15-year-old man with pancytopenia after induction cytostatic treatment of acute myelogenous leukemia was admitted to intensive care with diffuse pains affecting the extremities, abdominal tenderness to palpation, tender swelling of the left cubital fossa and beginning septic shock with increasing C-reactive protein. Therapy and clinical course Laboratory investigations showed signs of a massive hemolysis. The patient received hemodialysis due to lactacidosis (lactate 22.9 mmol/l) and hyperkalemia (potassium 7.7 mmol/l). Three hours after admission the patient developed crepitations in the left cubital fossa and in both thighs. Due to the rapidly progressing septic shock, the patient showed systemic circulatory failure requiring cardiopulmonary resuscitation and died four hours after admission. Clostridium perfringens was found in the peripheral and central venous anaerobic blood cultures. Conclusion Clostridium perfringens-associated infections frequently have a fatal outcome. Without antibiotic therapy, the disease shows lethal outcome. The early onset of an adequate therapy, results in 15-50% survival. The onset of early presenting symptoms like abdominal complaints, pains affecting the extremities or swelling should result in prompt antibiotic therapy with penicillin g, especially if risk factors like pancytopenia are present.

Inadvertent 2-Deoxy-2-[ 18F]Fluoro-D-Glucose Lymphoscintigraphy : A Potential Pitfall Characterized by Hybrid PET-CT

Purpose: To communicate an important pitfall in positron emission tomography (PET) oncologic staging using 2-deoxy-2-[ 18F]fluoro-D-glucose (FDG). Procedure: A 60-year-old man with a right upper lobe bronchogenic carcinoma was injected with FDG through a cannula in his left cubital fossa, with a small amount of the dose extravasating. Results: Images obtained one hour post-injection with a positron emission tomography-computerized tomography (PET-CT) scanner demonstrated linear FDG activity running with the left arm brachial vascular bundle and along collateral channels, and accumulation of FDG in a low left axillary lymph node of normal size and CT appearance. Conclusions: Following inadvertent extravasation, FDG appears to accumulate in regional lymph nodes in the same fashion as bone scanning agents or lymphoscintigraphy colloid. Physicians and technologists need to be aware of this important pitfall in order to avoid the false positive diagnosis of nodal metastases. The ability of PET to demonstrate lymphatics and lymph nodes indicates its possible future use in lymphoscintigraphy.

A CASE REPORT OF ANGIOLYMPHOID HYPERPLASIA WITH EOSINOPHILIA WHICH WAS DIAGNOSED AS PSEUDOANEURYSM OF THE ULNAR ARTERY PREOPERATIVELY

A 53-year-old female was admitted to our clinic because of a pulsating tumor at the left cubital fossa. A swollen lymph node was also palpated proximal to the tumor. The tumor was diagnosed pseudoaneurysm of the ulnar artery from angiographic findings. Both the tumor and lymph node were removed surgically. Histology of the tumor showed the formation of lymphoid follicles with infiltration of eosinophils, which suggested the diagnosis of Kimura's disease. However, further examinations including immunohistological studies, revealed further findings such as anomalous vascular proliferation, papillary growth of the endothelium with infiltration of eosinophils and marked infiltration of lymphocytes with lymphoid follicles. On the basis of these findings, the tumor was finally diagnosed as angiolymphoid hyperplasia with eosinophilia (ALHE). Previous cases of ALHE were reviewed, paying special attention to the differentiation between ALHE and Kimura's disease.